Is there no limit to this doctor's skills?

Chapter 206 Consultation!

"Brother Dong..." When Guo Ziyuan returned to the emergency room from the control room, he found Dr. Han Dong from the Department of Trauma Orthopedics chatting with Qian Shuhang and a few others.

Upon seeing Guo Ziyuan, Qian Shuhang quickly turned around: "Dr. Guo, you've come at the right time. Dr. Han came specifically to see you."

Han Dong is a trauma orthopedic surgeon and a student of Associate Professor Peng Qingsong from Zhongnan Hospital. Guo Ziyuan had a meal with him when he first came to Yishi.

Guo Ziyuan rubbed his hands with hand sanitizer: "Brother Dong, you could just make a phone call."

Han Dong: "I don't have that much influence."

"Dr. Guo, I've come here today because Director Lu would like to invite you for a consultation."

"Director Liu followed the proper procedures; it wasn't some private fooling around between the two of us brothers."

"Besides, since you're now working for Director Qian, I also need to come and report to him."

Qian Shuhang gave a half-smile: "Dr. Han, what do you need to report to me? You need to see Director Zhou."

Guo Ziyuan is not a doctor at this hospital; he is only temporarily working as an assistant at Yilan Central Hospital.

Therefore, Han Dong and his team couldn't get Guo Ziyuan to participate in the consultation process.

Sending a consultation request from the trauma surgery ward to the emergency department is a completely reversed procedure.

"Director Qian, it's the same whether I come to you or not."

"Director Lu was really annoyed by that patient in the department, which is why he asked me to invite Dr. Guo!"

"It won't take long."

"I wonder if it's convenient for Director Qian?"

Qian Shuhang immediately replied, "Is it convenient for Dr. Guo? Dr. Guo is just an assistant right now!"

The term "follower" refers to someone who doesn't have to take responsibility but has opportunities to perform tasks.

Ordinary assistants don't have many opportunities to perform tasks.

But Guo Ziyuan has plenty of opportunities to operate, so Qian Shuhang wouldn't dare to arrange for Guo Ziyuan to do so!

Firstly, I lack the necessary abilities, and secondly, I am not qualified for the position.

Guo Ziyuan came down to learn, not to serve as a beast of burden for the Central Hospital.

Ultimately, Guo Ziyuan hasn't even received your salary, so what gives you the right to order others around?

It was Zhou Yong who arranged for Guo Ziyuan to come from the control room to the emergency room.

"Director Qian, shall I go and take a look?" Guo Ziyuan agreed.

"Sure, Dr. Guo. You go ahead with your work." Qian Shuhang readily agreed.

He couldn't agree on behalf of Guo Ziyuan, nor would he refute Guo Ziyuan's agreement to go for the consultation.

This is the right way to get along with Guo Ziyuan.

……

On the way from the emergency department to the trauma surgery department, Han Dong gave Guo Ziyuan a brief explanation of the case.

"Tibial fracture, intramedullary nailing surgery, a year and a half ago, and it still hasn't healed at all?"

"This is nonunion." As soon as he stepped out of the elevator, Guo Ziyuan paused, resting his chin on one hand.

Simple tibial fractures are easy to treat; at Yilan Central Hospital, this is one of the cases that can be easily handled.

Han Dong nodded: "Yes, Dr. Guo, we've treated it as nonunion, but it still hasn't healed!"

Guo Ziyuan's brows furrowed instantly: "Was the pressure on the fractured bone ends too tight?"

For a fracture to heal, it needs blood supply.

If the fracture is reduced and fixed too tightly, it may affect local blood supply, leading to delayed healing or even non-healing.

"Not too tight, just right."

"In fact, Director Lu also consulted some professors about this case, and the professors also found it very strange."

"What's even stranger is that there were no particularly obvious signs of bone resorption on the fracture surface of this patient."

"Some people think that there may be a problem with local blood supply, but even with CTA, it is difficult to detect the nourishing arteries."

"Director Lu knows that Dr. Guo has excellent skills in interpreting films, so he would like to invite you to come over and take a look at the films to see if you can find any clues," Han Dong explained to Guo Ziyuan as they walked.

The two had just entered the ward when they heard people arguing at the nurses' station.

"Director Wu, what exactly happened?"

"Everything is fine, so why hasn't my husband's fracture healed?"

"This hasn't been going on for just a day or two, it's been a year and a half!"

In Han Dong's team, Lu Guoan is the chief physician, and Wu Qiong is the deputy chief physician and Han Dong's superior.

"After a fracture, there is always a risk of nonunion and failure to heal, but this risk is very small and rarely occurs."

"But once it happens, it's a very special case," Wu Qiong patiently explained to the woman.

"Is everything that hasn't grown up considered special, and therefore not a problem with your technique at all?"

"This has been going on for quite some time now."

"It's been over a year... I asked you last year, and you said the bone could grow back and the internal fixation was very good, but the healing might be a little slow."

Wu Qiong: "Medical technology is never 100% perfect."

"Technically speaking, if you can find any problems, I'll eat this table. You can send this film to any hospital and see whichever person looks at it!"

Middle-aged woman: "No problem, then why isn't it growing?"

"Medical technology is not like other technologies. No matter how good the technology is, accidents can still happen due to individual physical condition or other factors, which are unavoidable and unpredictable."

"We're also trying to figure something out..."

Middle-aged woman: "They can't even handle a simple fracture properly. When I first came, they said it was routine... They made it sound so convincing..."

Wu Qiong couldn't reason with him.

……

Han Dong and Guo Ziyuan remained silent, their expressions unchanged as they glanced past Wu Qiong and her family.

In the director's office, Lu Guoan also looked worried.

The director's office has a hanging X-ray reader, its white light shining through to illuminate the patient's X-rays and CT scans.

Lu Guoan is slightly overweight. At this moment, he is holding one hand behind his back and the other hand supporting his chin, carefully examining the position of the film viewer!

Then he started scratching the scalp on the back of his neck.

He was still completely baffled.

"Director Lu, Dr. Guo is here," Han Dong whispered a reminder.

In fact, Guo Ziyuan also looked at the location of the film reader immediately.

This patient's fracture was very simple, just a spiral fracture of the midshaft of the tibia, which was fixed with an intramedullary nail.

This kind of surgery... Guo Ziyuan had done it many times in his previous life.

Therefore, judging from the X-ray, the quality of the intramedullary nail fixation performed by Director Lu is indeed quite good.

The fracture line was almost invisible, the intramedullary nail was in place, and the patient's bone quality was quite good.

Logically speaking, with such a fracture surgery, the patient should be fully healed within three months.

However, the scans taken a year and a half later were almost identical to those taken a year after the surgery.

There's no callus at all!

This unusual scene surprised Guo Ziyuan as well.

"Dr. Guo." Lu Guoan turned around.

Guo Ziyuan turned his head: "Director Lu, this patient hasn't gone through any of the callus healing procedures yet?"

Fracture healing has its own inherent pathophysiological process.

It can be roughly divided into the induction phase, the inflammation phase, the cartilage callus phase, and the hard callus phase.

After cell death at the fracture site, the oxygen partial pressure in the hematoma decreases, the acidity increases, and the area contains kinins, prostaglandins, and non-collagenous proteins, as well as releasing various cytokines.

An inflammatory response began from this point.

However, it is quite strange that the fracture ends of this patient were so clean after the surgery.

"Generally speaking, the clinical healing time for spiral fractures of the tibial shaft is 8-12 weeks, but in this patient, the healing at this point is almost invisible."

"Does he have any underlying medical conditions?" Guo Ziyuan asked.

Factors affecting fracture healing can be divided into systemic factors and local factors, with systemic factors being the first to be considered.

For example, the patient may have diabetes, osteomalacia, scurvy, etc.

"No, we have carefully inquired about the patient's situation. The patient was previously healthy and suffered a tibial fracture due to an external injury."

"Apart from that, there's nothing special about it."

Lu Guoan turned his head and said, "Dr. Guo, when I consulted other experts, they mentioned that the fibula of this patient's lower limb may have been bearing weight."

"They suggested we perform an osteotomy on the fibula."

"But I think this patient doesn't actually have stress shielding on the fibula..."

Stress shielding means that the tibia, which should bear the stress of gravity, has its function replaced by the steel plate and fibula, thus reducing the stress at the fracture ends.

Guo Ziyuan shook his head: "For the fibula to replace the tibia in providing stress coverage, the patient would need to have an open fracture with partial bone loss, resulting in severe relative shortening of the tibia."

"The patient has a closed fracture, so there is generally no stress covering of the fibula."

"The lengths and courses of the tibia and fibula on the healthy and affected sides of the patient are almost equal."

"Therefore, fibular osteotomy to increase tibial stress is probably not advisable."

Guo Ziyuan then asked, "How was the swelling in your lower leg when you were injured? Is it possible that the soft tissue injury was severe?"

Han Dong: "It looks fine, nothing unusual."

"After the injury, there is redness and swelling in the local area, which is normal. The patient also showed no signs of compartment syndrome."

"Do you have any photos?" Guo Ziyuan asked.

Han Dong shook his head: "At the time, we only considered that his condition was okay, that it was a common disease, and we didn't think that he would have nonunion, so we didn't take any pictures."

The orthopedics department at Yilan Central Hospital wouldn't expect a simple spiral tibial fracture to result in nonunion, so they wouldn't be too wary.

"What about now? Do you have any?" Guo Ziyuan asked again.

Guo Ziyuan was specially invited by Han Dong for a "consultation," so Guo Ziyuan's tone was similar to that of a superior, which Han Dong could accept.

But Guo Ziyuan was, after all, a young doctor, and the way his superior acted so naturally made Han Dong take a few more glances at him.

What happened to Dong Ge? Is this how you treat your Dong Ge?

Han Dong showed Guo Ziyuan photos of the patient's lower leg taken in the last few days.

Guo Ziyuan did not find any particularly serious scars or defects.

Therefore, the concept of localized soft tissue loss or severe injury can also be ruled out.

Furthermore, since the nonunion was treated, there are surgical scars in the area.

Guo Ziyuan then asked, "Director Lu, when you treated the nonunion again, what was the blood supply like to the fracture ends?"

"It's not bad. We cleared away some of the hardened bone, and the blood supply is excellent."

"The surgery for nonunion was not performed by us; it was Professor Peng Qingsong from Zhongnan Hospital who performed it."

It is quite difficult and challenging for prefecture-level city hospitals to properly handle bone nonunion.

The patient's first surgery was performed at this hospital. To avoid further disputes, Lu Guoan did not attempt a second surgery on his own, but instead directly invited an expert.

Professor Peng Qingsong was very familiar with his mentor, who was also Han Dong's master's supervisor...

It's only natural that Lu Guoan would invite him over.

"The blood supply to the severed ends was still okay, but even after further fixation, it still didn't heal."

After repeating himself to himself, Guo Ziyuan scratched his head and asked, "Are you sure the patient hasn't been taking any medications privately?"

In his previous life, Guo Ziyuan had encountered many such fractures, but they were basically healed in one stage, and the patients were discharged directly.

When they came back for a follow-up appointment, they were able to walk normally again.

However, Guo Ziyuan also knew this.

Patients with nonunion fractures at provincial hospitals, Central South Hospital, Tongji Hospital, and Union Hospital were all "induced" by county hospitals or prefecture-level city hospitals.

It can be said that if city-level and county-level hospitals do not experience nonunion fractures, then these hospitals will basically be unable to conduct nonunion fracture treatment.

The number of cases is insufficient to achieve a large-scale operation.

Han Dong, the attending physician, was absolutely certain of this: "Definitely not."

After hearing this, Guo Ziyuan looked at the patient's CT scan.

Generally speaking, if a local fracture does not heal, there will almost certainly be a problem with local blood supply.

Poor blood circulation is the most direct cause.

Other reasons also lead to poor blood flow, which in turn causes fractures to fail to heal.

Or it could be due to an underlying blood disorder.

After ruling out systemic factors, the only remaining option is to look for local factors.

Because the fracture did not heal, the patient underwent several follow-up CT scans after surgery.

Therefore, it took Guo Ziyuan nearly twenty minutes to carefully read through all the CT scans from the follow-up examinations.

Neither Han Dong nor Lu Guoan argued with Guo Ziyuan.

After Guo Ziyuan put down the last film, Han Dong asked, "Dr. Guo, how is it?"

Upon hearing this, Guo Ziyuan scratched his head and said, "I feel that the situation is quite tricky."

"You mean... Dr. Guo."

Guo Ziyuan: "If I'm not mistaken, there's something blocking the blood vessels near his fracture."

"And it's alive!"

"You mean parasites?" Han Dong and Lu Guoan blurted out instantly.

"Did the parasites just happen to come here?"

Guo Ziyuan: "Yes!"

That's my guess!

Since no parasites were actually seen, Guo Ziyuan could only speculate.

"And it's moving around!"

"It's possible that the patient had finally achieved a period of fracture healing, but then the blood vessels supplying them were blocked!"

"Local bone cells have undergone necrosis and resorption."

"And so it goes..."

"What kind of parasite is that?" Lu Guoan asked bluntly.

Guo Ziyuan gave Lu Guoan a strange look.

He knew Lu Guoan didn't mean anything by it; it was just an instinct born out of sheer frustration.

But those are parasites, and parasites can't be identified just by a CT scan.

It doesn't reside permanently in the blood vessels...

"We'll have to dissect the local blood vessels and tissues to find it!"

"Take a biopsy or check other indicators!"

"This is really not my forte... By the way, where does this patient usually live?" Guo Ziyuan immediately thought of the films that Professor Min Chong, Chi Huanlin's uncle, had shown him.

"He's a local from Yilan, but he may have traveled abroad," Han Dong replied.

Guo Ziyuan nodded: "Oh..."

"Director Lu, this is just my guess. I think that as long as we can resolve these issues..."

"Whether medication or other methods are used, the surgery itself is not a problem."

"But as for how to solve it..."

"This CT scan is atypical, there's nothing I can do. Perhaps you could ask someone from the infectious disease department to come and consult?"

It is extremely rare for parasites to enter tissues and block blood vessels, but it still happens from time to time across the country.

The country is too big, and the population is too large.

Based on probability, even with a one in a hundred million chance, it could still result in more than a dozen offspring.

Lu Guoan and Han Dong exchanged a glance, their eyes filled with disbelief.

First, it is very rare for parasites to infest the area near the fracture site.

But Guo Ziyuan was able to see it, which is even rarer than rare parasites.